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Burden of chronic comorbidities among people living with and without HIV: disability-adjusted life years in British Columbia, Canada
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AIDS 2022 July 29-Aug 2 Montreal
Presenter
Ni Gusti Ayu Nanditha
Authors
N.G.A. Nanditha * (1,2), J. Zhu (2), L. Wang (2), J. Kopec (3,4), R.S. Hogg (2,5), J.S.G. Montaner (2,1), V.D. Lima (2,1)
Institutions
(1) University of British Columbia, Faculty of Medicine, Vancouver, Canada, (2) British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, (3) University of British Columbia, School of Population and Public Health, Vancouver, Canada, (4) Arthritis Research Canada, Richmond, Canada, (5) Simon Fraser University, Faculty of Health Sciences, Burnaby, Canada
BACKGROUND: To describe the burden of chronic comorbidities among people living with and without HIV (PLWH vs. PnLWH) in British Columbia (BC), Canada, we estimated disability-adjusted life years (DALY) related to these comorbidities.
METHODS: From a population-based cohort in BC, antiretroviral-treated adult PLWH were matched by age and sex to four PnLWH at baseline and followed for '¥1 year during 2001-2012. DALY combines years of life lost to premature mortality (YLL) and lived with disabilities (YLD). YLL were yearly death counts multiplied by standard life expectancies at death, while YLD were yearly prevalent counts multiplied by severity-specific weights. DALY associated with non-AIDS-defining cancers, diabetes, osteoarthritis, hypertension, non-HIV-related dementia, cardiovascular (CVD), chronic kidney, chronic liver and chronic obstructive pulmonary diseases (COPD) were measured for 2008-2012 cumulatively. Non-parametric bootstrapping estimated the credible intervals (CI) of YLL; for YLD, probabilistic resampling was conducted considering literature-derived disease-specific severity distribution.
RESULTS: At baseline, our matched cohort consisted of 82% males with a median age of 40 years (25th-75th percentiles: 34-47). At any point between 2008-2012, 7042 PLWH and 30,640 PnLWH were alive, leading to 5356.5 and 10,945.7 in estimated DALY, respectively (rate: 770.2 [95%CI: 710.2, 831.6] vs. 359.0 [336.0, 382.2] years/1000 people; Figure 1[C]). Similar to trends observed in Canada, cancers and CVD predominantly contributed the DALY. Except for hypertension, osteoarthritis (both populations) and dementia (PLWH only), the burden of most comorbidities was driven by YLL rather than YLD (Figure 1[A-B]). COPD and chronic liver contributed the third and fourth highest DALY among PLWH, as did diabetes and COPD among PnLWH.
CONCLUSIONS:PLWH experience disproportionate burden of chronic comorbidities compared to PnLWH. The observed disparities may relate to socioeconomic and lifestyle differences, residual HIV-related inflammation, and ART-related toxicities. Our findings highlight the need to enhance prevention and management of comorbidities as part of HIV care.
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